The long-term goal of this project is to prevent musculoskeletal injuries in Emergency Medical Service (EMS) workers. Prior work by our group and others has shown that EMS tasks contain many risk factors that have been associated with musculoskeletal disorders (MSDs) in the literature. In a previously funded NIOSH study focused on intervention design and development, we built two low-cost and biomechanically effective prototype devices for assisting in the lateral transfer of supine and seated patients. The bridgeboard reduces friction and therein promotes sliding patients between surfaces. The transfer sling provides handholds for securing and moving seated patients. Usability testing further refined these concepts into commercially viable products. We know that having well designed and validated interventions does not ensure their adoption and sustained use by affected workers. Hence the primary purpose of the current application is to further our understanding of research to practice (r2p) issues surrounding the adoption and sustainability of voluntary interventions aimed at preventing MSDs. Project Aims: 1. Using the framework of the integrated technology acceptance model and task technology fit model as a starting point, we will identify and quantify the degree to which specific perceptual and attitudinal factors contribute to the adoption and sustained use of previously validated musculoskeletal disorder (MSD) interventions;2. To quantify the degree to which individuals who step up and "champion" an intervention affect the adoption and sustained use of the intervention and to determine the nature of the successful efforts;3. To characterize, both quantitatively and geographically, the diffusion of two specific musculoskeletal interventions within and between EMS organizations. Methods. We propose to recruit and follow 108 professional EMS workers for a 3-month period. At baseline, upon receiving the interventions and monthly thereafter, the participants will be surveyed to assess attitudes and perceptions about the interventions (Aim 1). In addition, participants will be asked to report their use of the interventions on a weekly basis. These data will be used to assess the relative effects of these perceptual and attitudinal factors on actual intervention adoption and use using a theoretical path model derived from the literature. As each participant completes their involvement, they will be asked if and how they or other individuals "championed" the interventions (Aim 2). These data will be used to expand the path model used in Aim 1. Finally, we will study the patterns of MSD intervention diffusion within and between organizations by tracking purchase data (Aim 3). Taken together, these aims will allow us to identify opportunities for secondary interventions aimed at facilitating the adoption and diffusion of validated MSD interventions. PUBLIC HEALTH RELEVANCE: Sprains, strains, and muscular pain account for over half of the injuries suffered by firefighter/ paramedics while performing non-fire emergency tasks, such as emergency medical services (EMS), and consequently there is a need for effective interventions to improve and protect the musculoskeletal health of EMS workers. Building on our prior research that designed and tested assistive devices, this project is aimed at understanding the factors that contribute to the adoption and sustained use of interventions that can reduce the burden of musculoskeletal disorders among this and other groups of workers.